The proposed PROSPR Center will focus on developing and evaluating systems-based approaches to optimize care across the breast cancer screening continuum, for both individuals and populations, using health information technology (IT). This approach is timely as the widespread deployment and meaningful use of electronic health records (EHRs) provides infrastructure, opportunity, and incentive to develop systems-based solutions. We will address these issues within a regional network comprised of integrated clinical delivery systems, based in primary care with comprehensive data capture through breast imaging, pathology, and initial cancer treatment. Our three over-arching Projects/Specific Aims, supported by two cores, address key priorities and promote the quality of care: Aim 1: To improve breast cancer screening systems through measurement and feedback using a micro-systems approach to map the entire screening process and develop generalizable metrics to assess change, characterize process and screening outcomes, and develop and implement dashboard tools to measure and report these screening metrics; Aim 2: To promote personalized decisions for breast cancer screening for women and their providers by developing an EHR-integrated, personalized breast cancer screening module that will generate tailored risk assessment and screening recommendations for women and tailored decision support for their providers. and measure the reach, effectiveness, adoption and implementation in a practice-based randomized controlled trial; Aim 3: To compare the effectiveness of care processes across systems for established and emerging breast cancer screening modalities, promoting integration across the Center's projects by providing both quantitative and population estimates for Aims 1 and 2, and to assess the impact of emerging modalities (e.g., tomosynthesis). Our regional collaborative, with seasoned, multi-disciplinary expertise and a track record of collaboration in a national breast screening consortium, offers data on diverse populations and care settings and projects that are designed to improve the quality of care across the breast care continuum.